Affordable Care Act enrollment is slightly ahead of last year so far, despite expiring subsidies

Affordable Care Act Enrollment Rises Despite Looming Subsidy Expirations

Early data from the 2026 Affordable Care Act (ACA) enrollment period shows a moderate increase in sign-ups compared to last year, even as enhanced subsidies are set to expire at the end of 2025 – a change that could dramatically increase costs for millions of Americans.

According to figures released Friday by the Center for Medicare and Medicaid Services, nearly 5.8 million people had selected ACA plans by day 29 of the current enrollment window, representing an increase of approximately 400,000 enrollments compared to a similar point last year.

The numbers have surprised some observers who anticipated an immediate drop in marketplace participation due to the impending subsidy expirations. However, health policy experts caution that these early figures provide only a partial picture of total enrollment trends.

“Overall, it’s just too early to know what any of this means,” said Jason Levitis, a senior fellow in the health policy division at the Urban Institute.

The data reveals considerable year-to-year fluctuation in when people select their plans. This year’s current enrollment figures remain approximately 1.5 million below the 7.3 million sign-ups recorded 32 days into the enrollment period two years ago.

For most states, the window to enroll in ACA coverage that begins January 1 opened on November 1 and closes December 15. Americans seeking coverage with later start dates can continue selecting plans through January 15.

The ACA marketplace has experienced substantial growth over the past five years, with total enrollment doubling from approximately 12 million to over 24 million. This surge coincided with the introduction of enhanced tax credits, which significantly reduced premium costs for millions of Americans.

Should these subsidies expire as scheduled at the end of 2025, the consequences could be severe for many households. According to research from KFF, a health care nonprofit, the average subsidy recipient would see their annual premiums more than double.

The future of these tax credits has become a contentious issue in Congress. Senate Democrats are expected to vote this week on a proposal to extend the subsidies without major modifications. However, Republicans, who control the chamber, have already rejected this approach, and prospects for any extension are diminishing due to significant Republican opposition.

Several factors may explain the higher-than-expected early enrollment numbers. Levitis suggested that ongoing media coverage of the subsidy debate has likely increased public awareness of ACA options. Additionally, older Americans and those with chronic health conditions typically select their plans earlier in the enrollment period, regardless of cost increases, since they know they need continuous coverage.

“All of this stuff takes a while to diffuse through the system,” Levitis noted, adding that some enrollees may be downgrading to less expensive plans with higher deductibles rather than abandoning coverage altogether – a trend that wouldn’t be immediately apparent in the enrollment data.

The political implications of these enrollment figures are significant. Joe Antos, a health economist at the American Enterprise Institute, suggested that Republicans might use the data to argue that expiring subsidies won’t substantially impact health coverage affordability.

However, Antos emphasized that many Republican representatives in competitive districts understand they could face voter backlash if subsidies expire without a replacement. “That’s not going to change what politicians in red states know,” he said, noting particular vulnerability among Republicans representing working-class constituencies who benefit from the current subsidies.

The ACA marketplace’s evolution over the past decade demonstrates its increasing importance in America’s healthcare landscape. Five years ago, approximately 12 million Americans selected ACA plans. Today, over twice that number rely on the marketplace for their health insurance coverage, making any policy changes potentially consequential for millions of households across the country.

As the December 15 deadline approaches for January coverage, both healthcare advocates and policymakers will be closely watching enrollment trends for indications of how Americans are responding to the prospect of substantially higher premiums in 2026.